Prostate cancer treatment in Israel: Removing an enlarged prostate using incision-free (closed) surgery
A brief guide to a TURP prostatectomy
Enlarged prostate: Benign prostatic hyperplasia (BPH)
An enlarged prostate, also known as benign (non-cancerous) enlargement of the prostate, is quite common among men aged 50 and over. Typically, the only action that patients need to take is to simply follow up regularly with their urologist.
When the enlargement is accompanied by symptoms such as difficulty urinating, increased urinary frequency, or pressure urinating even at night, painful urination, or a feeling of a full bladder, patients may be prescribed medication. When medication does not help, physicians may offer surgery as an alternative.
About TURP: Closed prostate resection
TURP surgery is performed through the urethra under regional anesthesia, usually a spinal block or epidural. The surgeon inserts a thin metal tube and an optical fiber into the urethra. The optical fiber transmits an enlarged image of the area onto a screen for the surgeon to view. The surgeon then inserts a special wire loop that discharges an electric current used to precisely cut away the tumor, and then “burn” the healthy prostate tissue so it does not bleed.
The excised tumor will usually be sent for pathological examination to determine its characteristics and confirm, among other things, that it is not cancerous. The doctor can assess this quite accurately before the resection, but the pathological examination will confirm this diagnosis definitively.
TURP surgery is not very complex, and recovery is relatively easy because it is a minimally invasive procedure, not requiring a large surgical incision in the groin area. Patients are typically discharged from the hospital within 48 hours. Return to routine takes about one week; however, patients should not exert themselves for about six weeks. It is very important to drink a lot of fluids, which will help the urinary system recover and function properly.
What are the possible adverse effects of closed prostate resection surgery?
As with any invasive surgery, there may be risks and complications. The risks of the operation may be related to the anesthesia before, during, or after the prostate surgery. Complications may include bleeding at the surgery site, urinary retention, infection, or narrowing of the urethra. Short-term urinary incontinence is rare, and permanent impairment of urinary control is very rare.
A rare complication of prostate surgery is transurethral resection syndrome (TUR), in which fluid from the bladder is absorbed into the bloodstream. Symptoms range from an uncomfortable feeling in the body to a severe salt imbalance.
About 50% of patients who undergo the surgery will continue to have ejaculations, which will be manifested in a normal orgasm but without the ejaculation of semen (retrograde ejaculation). In this situation, the seminal fluid returns to the bladder and exits with urination. It is important to emphasize that retrograde ejaculation does not interfere at all with normal sexual function, but, of course, affects fertility.
Up to five percent of TURP patients report sexual dysfunction (sometimes to the point of complete impotence).
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